Reddy Thugu S, Myers James W
James H. Quillen College of Medicine, East Tennessee State University, USA.
Am J Med Sci. 2003 May;325(5):288-91. doi: 10.1097/00000441-200305000-00007.
Strongyloidiasis stercoralis hyperinfection presenting as vasculitic-like skin lesions is rare. An autoinfection cycle allows intestinal strongyloidiasis, usually a benign infection, to persist for many decades. We report a woman with disseminated S stercoralis infection presenting as nonpalpable purpuric skin rash and syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Upon admission, she was treated with corticosteroids for her vasculitic skin lesions, which then worsened her status. When the diagnosis was recognized, steroids were stopped, thiabendazole treatment was instituted, and she gradually recovered. Serious or fatal infection can occur in patients with strongyloidiasis who were treated with immunosuppressive drugs. Stool specimen screening and/or serological tests for S stercoralis infection in patients who require immunosuppressive therapy helps to prevent complications before embarking on such treatment. Unexplained hyponatremia, severe hypoalbuminemia without proteinuria, and unusual skin rashes, especially over the lower aspect of the abdomen and upper aspects of the thighs, in persons living in areas endemic to S stercoralis should raise suspicion of S stercoralis infection.
粪类圆线虫超感染表现为血管炎样皮肤病变较为罕见。自身感染循环使得肠道粪类圆线虫病（通常为良性感染）能够持续数十年。我们报告了一名患有播散性粪类圆线虫感染的女性，表现为不可触及的紫癜性皮疹和抗利尿激素分泌不当综合征（SIADH）。入院时，她因血管炎性皮肤病变接受了皮质类固醇治疗，这反而使她的病情恶化。确诊后，停用了类固醇，开始使用噻苯达唑治疗，她逐渐康复。接受免疫抑制药物治疗的粪类圆线虫病患者可能会发生严重或致命感染。对于需要免疫抑制治疗的患者，进行粪类圆线虫感染的粪便标本筛查和/或血清学检测有助于在开始此类治疗前预防并发症。生活在粪类圆线虫流行地区的人群中，不明原因的低钠血症、无蛋白尿的严重低白蛋白血症以及不寻常的皮疹，尤其是腹部下方和大腿上部的皮疹，应引起对粪类圆线虫感染的怀疑。
